Background

Ventricular arrhythmias (VAs) ablated successfully at the right–left subvalvular interleaflet triangle (R-L ILT) between right and left coronary cusps have not been fully characterized.

Objective

The purpose of this study was to investigate the electrophysiological characteristics of these VAs and their relationships with the left ventricular (LV) summit.

Methods

Twenty-eight VAs ablated successfully at the R-L ILT were studied.

Results

Ninety-six percent of VAs had an early precordial electrocardiographic transition. R-wave amplitude in lead V₁ was relatively high (RS morphology, R-wave amplitude 0.35 ± 0.09 mV; R/S ratio 0.35 ± 0.27), whereas the morphology of lead I was R-shaped in 71% and M-shaped in 50% of VAs. Earliest potential was recorded at the R-L ILT in 13 of 28 patients and the left pulmonary sinus cusp (LC) in 6 of 28 patients. Mapping the summit communicating vein (summit-CV) failed because of anatomic or instrumental limitations in these 19 patients. In the other 9 patients, earliest potential was successfully recorded at the summit-CV, while perfect pacemapping was achieved. Poor pace mapping was achieved at the R-L ILT or LC in most patients (27/28). Target site was located at the top of the R-L ILT in all cases. A presystolic potential was present at the target site in 18 of 28 patients. A U-curve via the retrograde method was conventionally used to reach the top of the R-L ILT.

Conclusion

VAs ablated successfully at the R-L ILT have unique electrophysiological characteristics, and R-L ILT may be an endocardial anatomic ablation target for VAs originating from the base of the LV summit.

中文翻译：

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室性心律失常在左右冠状动脉尖瓣间瓣下三角区成功消融：电生理特征和导管消融

背景

在左右冠状动脉尖头之间的左右瓣下叶间三角 (RL ILT) 成功消融的室性心律失常 (VAs) 尚未完全表征。

客观的

本研究的目的是调查这些 VA 的电生理特征及其与左心室 (LV) 峰的关系。

方法

研究了 RL ILT 成功消融的 28 个 VA。

结果

96% 的 VA 有早期的心前区心电图转变。_{V 1}导联 R 波幅度相对较高（RS 形态，R 波幅度 0.35 ± 0.09 mV；R/S 比 0.35 ± 0.27），而导联 I 的形态在 71% 为 R 形，在 50% 的 VAs 中为 M 形。28 名患者中有 13 名在 RL ILT 记录了最早的电位，28 名患者中有 6 名在左肺窦尖 (LC) 记录了最早的电位。由于这 19 名患者的解剖学或仪器限制，绘制顶部交通静脉 (summit-CV) 失败。在其他 9 名患者中，最早的电位在 Summit-CV 处成功记录，同时实现了完美的起搏。大多数患者 (27/28) 在 RL ILT 或 LC 处获得了较差的起搏映射。在所有情况下，目标站点都位于 RL ILT 的顶部。28 名患者中有 18 名在目标部位存在收缩前电位。

结论

在 RL ILT 成功消融的 VAs 具有独特的电生理特征，RL ILT 可能是源自 LV 峰底部的 VAs 的心内膜解剖消融目标。